Greta Frontero’s story on e-cigarette use at Westfield High School started getting blowback before the school paper had a chance to publish it early this year.

“People were like, ‘Everyone’s going to hate you for this. They’re all going to be pissed,’” says Frontero, 18, who graduated in June and is an incoming freshman this fall at the University of Wisconsin.

“I didn’t like hearing those things,” she recalls. “But it only made me want to write the story more.” She knew her piece would generate lots of attention among adults who have caught on that e-cigarette use—or vaping—is rampant in schools and potentially dangerous. And the content was irresistible. Frontero’s Westfield High peers told her things she knew they wouldn’t tell just anyone.

The stories described how students are secretly vaping in school and at home, often using a Juul, the USB-shaped e-cigarette device teens favor. Juuls are less than 4-inches long and easily hidden—and apparently easy to acquire, although state law prohibits the sale of vaping devices to anyone under 21.

“It’s not uncommon for me to hit my Juul in bed, while doing homework and stuff like that,” one senior girl told Frontero. Another characterized her e-cigarette use during the school day as a way to take the edge off: “If I get an opportunity to Juul in school, I take it,” she said. “It’s sometimes a nice feeling when I’m stressed out.”

A senior boy outlined the series of events that led to his three-day suspension earlier in the school year. During chemistry class, he was overcome by the urge to inhale the flavored nicotine his Juul released, he told Frontero. So when his teacher’s back was turned, “I took a hit of it and blew it in my sweatshirt.”

Alas, while a Juul is easy to hide, the substantial volume of smoke (actually, vapor) from an e-cigarette is not. In this boy’s case, the teacher observed vapor escaping his sweatshirt. “When my teacher asked why there was smoke coming out of my jacket and I opened my mouth to respond, more smoke came out of my mouth.”

Vaping has created a cloud of anxiety for New Jersey schools. More than a behavior crisis, it is viewed as a health crisis.

Juuls and similar e-cigarette devices vaporize liquid nicotine rather than burning tobacco and creating tar. They were designed—and continue to be marketed—as a healthier alternative to conventional cigarettes that can be used to wean smokers off tobacco. But the nicotine in vaping liquid, like nicotine inhaled from anything, presents a health risk.

As the new school year begins, high schools and, increasingly, middle schools across the state are arming themselves to battle vaping—but some say they are no closer to extinguishing the problem than they were about four years ago, when they started recognizing the trend. The American Lung Association reports a 900 percent increase in the use of e-cigarettes among high school students between 2011 and 2015. In New Jersey, 12.1 percent of high school kids use e-cigarettes, according to an April report by the nonprofit Tobacco Free Kids. Overall, more than 9 million Americans vape regularly, according to the Centers for Disease Control.

School administrators say the near-odorless, and therefore hard-to-detect, habit is gaining ground each year, as evidenced by the proliferation of discarded Juul cartridges in school bathrooms and parking lots. Prevention and counseling organizations like Wellspring, in Middlesex County, are observing side effects, including an increase in regular cigarette use among teens, the first such rise since the 1980s. Some schools are so convinced of the pernicious effect of vaping on young bodies and minds that they consider any act of e-inhalation an emergency, worthy of a trip to the ER.

Kinnelon High School in Morris County adopted strict rules on vaping in 2015. “If a parent is not available within two hours of a child being caught with a vaping device, we’ll send them to the hospital in an ambulance,” explains principal Gary Suda.

In May, the U.S. Food and Drug Administration issued a warning about vaping liquids that contain nicotine, saying accidental ingestion can cause injury or even death. But that’s not the only danger. The same month, an exploding vape device killed a Florida man. In a 2017 report on 195 incidents of e-cigarette-related fires and explosions, the United States Fire Administration cites e-cigarettes that use lithium-ion batteries, the type that power Juuls, as a “new and unique hazard” because they are prone to explosion. “No other consumer product places a battery with a known explosion hazard such as this in such close proximity to the human body,” the report says.

Vaping liquids contain varied levels of nicotine, ostensibly so those trying to quit smoking can work their nicotine consumption down to zero. They also contain candy-like flavorings (to make them more appealing), and in some cases, synthetic additives of unknown origins.

“I’m concerned about the synthetic nature of these substances that are coming from overseas and other locations,” says Suda. “We don’t know how harmful it might be.”

Indeed, a National Academy of Sciences study released early this year concludes, that while switching from cigarettes to vaping reduces health risks related to tobacco, the chemicals in e-cigarettes are themselves potential risks.

Some of the additives or oils that can be bought at vape shops or online contain high concentrations of THC or other chemicals users inhale to get high. Food allergies are another concern. “We don’t know if the additives might be derived from something like tree nuts,” says Diane DiGiuseppe, the Kinnelon School District superintendent. Thus, the drastic-sounding measures she and Suda adopted for Kinnelon, measures they say are proving effective.

Students caught vaping at Kinnelon are directed to empty their pockets and turn over their backpacks for searching. The searches often turn up more vaping paraphernalia, says Suda. The offenders are then sent to the school nurse’s office, where their vital signs are checked. Parents are notified somewhere between the pocket emptying and the visit to the nurse. They have two hours to collect their offending student and bring him or her to the hospital or a family physician for a urine screen and medical check. (Ambulance trips are rare, Suda says.)

Thankfully, the post-vape medical screenings usually don’t turn up any problems more serious than vaping. “The majority of the screenings come back nicotine only,” says Suda, a father of four who says nicotine-addicted students often confide in him about their struggle to quit. Kinnelon’s relative affluence and the community’s investment in awareness campaigns to keep kids safe likely has something to do with the offenses being limited to nicotine and nothing stronger, he says. Those same factors probably limit the school’s overall incidence of vaping. In the 2016-2017 school year, a dozen Kinnelon students were caught vaping. This past year, that number was cut in half.

Kinnelon and other districts around the state have sought professional help in handling the vaping crisis, calling in school-safety experts like Timothy Shoemaker, a Bergen County police sergeant whose Morris Plains company, MPoweredParent, runs workshops nationwide. In an e-mail interview, Shoemaker said vaping entered his presentations in 2013. Requests have since gone through the roof. “We’re closing out the school year with about 35 presentations for 2017-2018,” said Shoemaker. “The first half of 2018-2019 is almost completely booked.”

That’s just in New Jersey. And the bookings aren’t only for high schools. Shoemaker says about one-third of the presentations he’ll give this school year will be at middle schools. (In Kinnelon, the middle school principal found a discarded Juul cartridge hidden behind a loose tile in the boys’ bathroom this year.)

Shoemaker acknowledges that anti-vaping forces are fighting an uphill battle. “We have clearly hit a tipping point where the marketing and social endorsement of vaping has vastly outspent, outshouted and outpaced our prevention efforts.”

Any parent who has found a spent cotton-candy-flavored Juul pod in his or her child’s backpack knows what Shoemaker is talking about. (Frontero says cucumber and mint are the flavors of choice at Westfield High.)

Nashon Hornsby, a lawyer and assistant commissioner with the New Jersey Department of Health’s community health services division, also has issues with the marketing of vaping products. “Part of the incline we’re seeing in the use of e-cigarettes among young people is because of the way these items have been marketed, with the flavorings kids like and all the other features, including the design of the devices themselves, which makes them hard to detect,” he says.

Although it appeals to all kinds of users, Juul is careful in its marketing to emphasize the potential benefits of e-cigarettes. On its website, the company states: “Juul was created to be a satisfying alternative to cigarettes. Learn about our mission to improve the lives of the world’s 1 billion adult smokers.”

The mushrooming of shops with fun-sounding names like Planet of the Vapes and Darth Vapor presents another challenge. Some New Jersey towns—such as Newton—have banned the stores. But Dawn Francavilla, director of student life and a dean at the Wardlaw-Hartridge School, a private school in Edison, and the vice president-elect of health at the 99-year-old New Jersey Association for Health, Physical Education, Recreation and Dance, says a colleague from that organization counted nine vape shops in a one-mile stretch of Route 9 near her home in Freehold.

The e-cigarette industry’s efforts are only part of the pitch to kids. At his presentations to parents and school staff, Shoemaker dazzles the uninitiated with a smorgasbord of vaping paraphernalia, like shoes with hidden compartments for vape cartridges and hoodies with strings that can be used as inhalation tubes.

More insidious still, according to DiGiuseppe and Francavilla, is the way the Internet seduces new users. YouTubers are racking up views for blowing voluminous smoke plumes and challenging followers to out-fog them. They’re also attracting followers with exhalation tricks like nose rings made of vape steam. Francavilla says there are also YouTube videos that show how to make your own e-cigarettes, which can be larger and more potent.

Even if students don’t buy into the health risks of vaping, they do understand consequences of getting caught. Kinnelon suspends first-time vape offenders for a single day. Westfield High students caught vaping are suspended for three days, which can affect their grade-point average. Some schools are considering imposing clean-air violations, with fines, says Suda.

It’s also clear to students that they are being watched. “We have staff who work hard watching surveillance [videos]. If they see the same kids going in and out of the same bathrooms, they know something’s up,” says Suda. A class III officer is also tasked with patrolling for smoke plumes.

In Burlington County, the Lenape Regional School District installed sensors in bathrooms in its four high schools earlier this year; it is believed to be the first district in the state to do so. Matthew Webb, director of programs and planning for the district, says it’s too early to comment on the effectiveness of the sensors.

Frontero, who admits she tried vaping twice at parties, says she understands school administrators’ desire to be vigilant. “It’s such a new thing, so I get it. When I interviewed my principal, he was talking about how people can put heroin in [a vaping device], which I had never heard of,” she says. The habit itself makes less sense to Frontero. “I don’t really see what the big fuss is, why people like it so much. We were finally past the stage when kids were getting addicted to cigarettes. And now there’s this. It’s depressing if you ask me.”